I was first admitted to Cwm Seren on August 4th 2006. I was 23 years old. I was already under the care of the local community mental health team and after a particularly distressing episode, it was suggested that I receive an assessment in hospital. I went voluntarily, though I do fully believe that if I’d refused I would have been sectioned.
At the time I had no idea where the ward was. Even growing up in the shadow of St David’s Hospital, it didn’t really occur tome that there were still patients there. I assumed that Cwm Seren was part of Glangwili Hospital.
Two CPN’s took me straight from the Resource Centre in Wellfield Road (I had gone there to see the on-call nurse because I was ‘in crisis’ and didn’t feel safe). By this point they had explained everything to my Mother, who had come with me (I was still living at home at this stage).Mum needed to know where to bring my clothes and it was then I discovered that I would be staying in the place that as children, we would mercilessly make jokes about. We all knew that it was where ‘the dangerously mad psycho people, dribblers and window lickers lived’. We knew that ‘talking to yourself or an imaginary friend would get you a spell in the loony bin’. We knew it was cruel to refer to people this way, but the idea of madness frightened us into a peculiar sense of humour.
Oh, how the tables had turned. Now I was one of those who (probably not more than a decade previously) we had made fun of in school. Shame is a powerful thing. I’m glad I grew up.
Entering the grounds, I was absolutely petrified. The old buildings gave an instant sense of foreboding and doom, as if once I was inside I was never going home. To my surprise, we drove past the old buildings and continued towards the back of the grounds to more modern buildings. In my anxious state, I had forgotten that the original buildings no longer housed patients and were being converted for use by the council, or slowly decaying.
We pulled up outside a stylish modern building about a million miles away from the archetypal ‘gothic asylum’ that everyone pictures thanks to Hollywood. This was a light, airy, pastel coloured ward, with no bars on windows and a quiet sense of calm. But I did note that we were let in by a member of staff who locked the front door behind us. I was later informed that the reason for this was a few patients kept trying to go home but were too ill to leave the ward. I was put to sit in a room next to the nurses office while the CPN’s (community psychiatric nurse) did a handover. My Mum arrived with a bag of clothes and toiletries. We hugged briefly and then she left. I felt so scared, not of the building or the people, but of my own mind. Would I ever get well? Would I lose all my friends?
The next thing I realised, I was being led down the corridor. I was having dissociative episodes lasting from seconds to an hour or more, and finding myself somewhere different to where I had been a few minutes earlier was not unusual, but still disconcerting. I was shown to room 3 and was surprised at how big the room was – quite a bit bigger than my bedroom at home. I was also surprised that I would be on my own. I had been expecting a dormitory style room with maybe eight beds, lockers at the bedsides, curtains around the beds and horror of horror, shared bathrooms. Instead I had a bed, bedside cabinet, chair, chest of drawers, wardrobe and bookcase. I had my own shower, sink and toilet. I had a decent sized window and was able to see the field behind, (but the window only opened a few inches to prevent absconding). I could even lock the bedroom door. The door itself was one that could be unlocked from the outside and in case a patient barricaded themselves in their room, all the bedroom doors had a mechanism built into the door frame so that it would open in the opposite direction. There was a window at the side with blinds you could close, but staff were able to open them to check on you.
There were two rectangular panels above the bed, which for a long time I thought had cameras in, but it turned out that they were actually night lights that the staff would use to check you during the night without disturbing your sleep. Some staff preferred to shine a torch through the window at the door, as the night lights were actually bright enough to read by and actually disrupted sleep by being on all night. So unless there was a specific reason, the night lights hardly seemed to go on.
The nurse who showed me to the room explained she would go through my bag with me. I was told I couldn’t keep my belt, but I could keep my phone and charger. Every item was documented and I was given a pat down to check for anything sharp that I might use to hurt myself. Then I was given forms to sign regarding my voluntary status, and a promise to respect confidentiality. I was also given forms to sign agreeing to abstain from violence and aggressive behaviour (not really an issue in my case).
Then I was shown around the ward. There were 20 beds in use on the acute ward, with a smaller area through a set of locked doors that contained the psychiatric intensive care unit which had four beds. The set up suggested that originally, PICU (psychiatric intensive care units) was designed to be a six to eight bedded ward, but four beds were being used for acute admissions because of overflow. There was a mixture of male and female patients. There were two day rooms (smoking and non-smoking) a dining room with pool table and jigsaw puzzles, a laundry room, a bathroom with a bath in, store cupboards, the medical room, offices for doctors and the staff office, which had big glass windows so they could keep an eye on things. The occupational therapy corridor had art rooms, a kitchen, gym and computer room as well as a relaxation room.
The gardens were spacious with benches to sit on, but you were surrounded by a ten foot fence that was almost prison like but without razor wire on the top.
I was filled in on the basics of medication and food times, and told that as I was on fifteen minute checks I would not be able to leave the ward unescorted or until the psychiatrist had seen me. Which meant I was there for the weekend as it was after 4pm and consultant psychiatrists don’t work weekends. The medical doctor gave me a check over and asked many questions to which I no longer remember the answers I gave. Then I was free to sit in the day room the garden or my bedroom.
The weekend passed in a haze of questions, strangers, checks and total disconnection from real life.
Monday morning came around and I had slotted into the weekend routine already. Get up, have shower, have breakfast, have medication, wander round the garden and the ward for a while, watch telly, have lunch, repeat morning routine, cuppa at 2.30pm, more waiting or wandering, tea time around 5.30pm, then more wandering until bedtime at 10.30pm after night time meds were given. But Monday was the start of an amended routine. I was introduced to the occupational therapy team – which should have been my first clue as to what was coming.
I saw the psychiatrist some time in the afternoon. She was the same one I had at Wellfield Road, so there was a sense of continuity. She explained that they wanted to do a more in-depth assessment and that it would be preferable if I stayed in for the time being. Again, the impression I got was that if I refused, a section would be applied for. I had already gathered from other patients that being sectioned was far more restrictive than being voluntary, so I knew it was not worth challenging.
I was granted grounds leave of thirty minutes at a time, and because I had a mobile phone, the ward could contact me or vice versa if I was delayed. I took a quick wander that evening, but didn’t want to stray too far from what had already become my safety net. As I was allowed more time off the ward, I explored further. I knew that my late Stepmother had been a student nurse at the hospital in the late 1970s and that she had lived in the nurses’ home for a while, so I went for a good explore! As it happened, I came across an old site map on a signpost by the church which was faded and dirty. I was able to determine the map represented the hospital as it was in the late 1980s/ early 1990s by looking at the advertisements and their corresponding phone numbers around the edge.
The map was still fairly legible and I determined where the nurses’ home was. Now mostly derelict, it would have been a good solid building when in use. I discovered that I was able to walk in the walled gardens of the original main building. The walls looked like they were not that high (I actually managed to climb one from the outside) but there was, on the inside, a large dip running around the length of the wall which was apparently a common feature in Victorian asylums. This gave the impression that the patients were able to roam freely, but actually prevented escape as the wall was much higher from their side. I was able to look in the downstairs windows of Taf ward which was empty and had been for some time. The paint was peeling on the walls inside due to damp and the windowpanes were dusty, but I was able to spot the old curtain rails that would have afforded (a little) privacy to the inhabitants. What struck me most was the old LP records on the windowsill.
The sudden abandonment of possessions, left to warp and melt over several summers. I didn’t go over to the old Solva and Skomer wards as they seemed to be in use by the council. I later discovered that they had been the isolation wards before tuberculosis (TB) became treatable. Some of the staff and patients on Cwm Seren had spent time on Skomer/Solva in the past and apparently every bedroom had a door that led straight outside – in line with TB treatment practices from the late 19th and early 20th century. Once they had been decommissioned and (I assume) thoroughly decontaminated, they were eventually turned into general wards, and only closed once Cwm Seren was built.
I discovered that there was a patients cafe in the large red brick building opposite Cwm Seren. The four wards that had been there according to the map (Caldy, Cothi, Brechfa and Dulais)were long gone and the building was slowly being refurbished with the intention of housing corporate staff. The cafe closed about a year later.
There were patients from Alun/Duad wards who would come and sit on the bench outside Cwm Seren or use the café. I noticed that they were all elderly, many of them had poor cognitive skills and walked at a slow shuffle. I got the impression that most of them had spent a large number of years, decades even, in one hospital setting or another. There was also a small house called Ty Bryn. I was told that the residents there were severely autistic and learning disabled, with challenging behaviour and physical health issues that required nursing care. I was told that one of the residents had spent almost their entire life in hospital because in the 1960s, that’s what happened to people with learning and physical disabilities.
There were people on Cwm Seren that would have benefited from being in more specialist care due to a learning disability. Again, some of these patients had spent their lives in and out of hospital and were pretty much institutionalised. One person had already spent two years in Cwm Seren. The staff worked hard to accommodate their needs, but in an acute ward with a rapid turnover of beds this wasn’t always possible and frustration and boredom was evident.
On my first Wednesday there, I was introduced to the concept of ‘ward round’. If you are not used to being shown into a room already full of strangers then you tend to get a bit anxious, clam up and just agree to everything they say. I knew I was there for a while, so I went with the flow. As the days went on, I was given the opportunity to attend occupational therapy, which I thoroughly enjoyed as it meant I had a chance to explore my artistic side.
In between filling in various questionnaires regarding how I felt and what I was thinking, occupational therapy and daily routine, plans were being made for me to have overnight leave. Unfortunately my Mother felt unable to cope with my emotional state and requested that I not return home. She had a long chat with my named nurse and it was explained to me that Mum wanted me to move out.
This set me back and I spiralled into a severe depression. Several people on the ward were receiving ECT (electroconvulsive shock therapy) and I worried that it might be suggested as a treatment for me. While I understood that in some circumstances it could be very beneficial and potentially life saving, I witnessed the negative effects of treatment on some patients. Memory loss, sleepiness, the shakes. One lady had a total breakdown when she realised that the only way she would get off her section was to have ECT. On more than one occasion, a patient would return from ECT to discover that a new patient was in their room and they had been moved to another room. This was confusing for some of them.
Bed swapping was common. One night, one of the male patients had to transfer to Teilo ward in Glangwili hospital because of a lack of available beds on the female wing there. The male side of Teilo had surplus beds and because we were a mixed gender unit it was easier to do a swap. There were also patients who were over 65 on Cwm Seren but the EMI (elderly mentally infirm) units attached to the general hospitals were often full, so there was nowhere else in the health board’s catchment area for them to go. It was the same for the working age adult inpatient service. The lack of a beds meant we had patients from Pembrokeshire, Llanelli, and Ceredigion, even though there were locally based wards in those areas. People would be allowed home on leave but would often find their bed had been reallocated to a new patient on return, with no alternative provision. Future admissions over the next 10 years would see me visit Afallon ward in Aberystwyth (now closed) Bryngofal ward in Llanelli, a night in Teilo just before it was permanently closed, and most recently, St Caradog ward in Haverfordwest.
My first admission lasted around eight weeks and once I had secured a place to live, I was able to sleep off the ward although I was still under their care until the end of October 2006. My relationship with my family remained rocky for a few years until I was able to receive Dialectical Behavioural Therapy. It’s much better today. I managed to go four years from 2010 to 2014 without admission to any unit, and all my admissions since 2008 have been less than a week. The service has undergone massive changes in the last ten years and in my opinion not all of those changes have been positive. People are now being sent hundreds of miles away due to lack of beds and funding, local teams are heavily overloaded and it’s costing people’s lives. On the plus side, I recognise that I was lucky enough to get the help I had with minimal fuss. Almost all the staff I’ve met over the years have been really kind and caring, with a real passion for the job.
Staff – Dr Huw